Liver Fibrosis in HIV/Hepatitis C Coinfection: HIV Protease Inhibitors May Be Protective.A study of 182 patients at a major hospital in France suggests that HIV HIV (Human Immunodeficiency Virus), either of two closely related retroviruses that invade T-helper lymphocytes and are responsible for AIDS. There are two types of HIV: HIV-1 and HIV-2. HIV-1 is responsible for the vast majority of AIDS in the United States. protease inhibitors Protease Inhibitors Definition A protease inhibitor is a type of drug that cripples the enzyme protease. An enzyme is a substance that triggers chemical reactions in the body. may help to reduce liver fibrosis and cirrhosis in patients with both HIV and hepatitis C Hepatitis C Definition Hepatitis C is a form of liver inflammation that causes primarily a long-lasting (chronic) disease. Acute (newly developed) hepatitis C is rarely observed as the early disease is generally quite mild. . [1] This study, conducted in patients with both hepatitis C and HIV, was done to determine if protease inhibitors were really harmful to such patients, as had been reported in some cases. In fact, the opposite was found; use of protease inhibitors was associated with significantly less liver damage in this study. No one knows why, although the authors suggested several possible mechanisms. This new study is the first large, long-term followup of coinfected patients which included liver biopsy Liver Biopsy Definition A liver biopsy is a medical procedure performed to obtain a small piece of liver tissue for diagnostic testing. Liver biopsies are sometimes called percutaneous liver biopsies, because the tissue sample is obtained by going data -- which may help explain why it found different results. The new study, published in the August 2000 Hepatology, analyzed a cohort of patients who had been treated at the hospital between 1995 and 2000, and on whom careful medical records had been kept. A statistical analysis found four independent predictors of progression to cirrhosis (severe scarring of the liver): absence of protease inhibitor therapy (relative risk 4.74), heavy alcohol use (greater than or equal to 50 grams per day -- about 5 drinks a day -- relative risk 4.71), CD4 count under 200 (relative risk 2.74), and age greater than 20 years at the time of hepatitis C infection (relative risk 2.74). The protective effect of antiretroviral treatment was found only for protease inhibitors, not for nucleoside analog drugs. (There were not enough patients treated with NNRTIs, such as nevirapine nevirapine /ne·vir·a·pine/ (ne-vir´ah-pen) a nonnucleoside inhibitor of HIV-1reverse transcriptase, used in combination with other antiretroviral agents in the treatment of HIV infection. or efavirenz efavirenz /ef·a·vi·renz/ (ef´ah-vi?renz) an antiretroviral, inhibiting reverse transcriptase; used in the treatment of HIV infection. e·fa·vir·enz n. , to make a comparison.) The authors suggested that using protease inhibitors in HIV therapy, reducing alcohol consumption, and keeping CD4 counts high might be beneficial in coinfected patients. This study was limited because it was not a randomized ran·dom·ize tr.v. ran·dom·ized, ran·dom·iz·ing, ran·dom·iz·es To make random in arrangement, especially in order to control the variables in an experiment. trial where patients were randomly assigned to use protease inhibitors or not, with long-term followup with liver biopsy. The authors noted that such as trial would be impossible for both ethical and practical reasons. References (1.) Benhamou Y, Di Martino V, Bochet M, and others. Factors affecting liver fibrosis in human immunodeficiency virus- and hepatitis C virus-coinfected patients: Impact of protease inhibitor therapy. Hepatology. August 2001; volume 34, pages 283-287. |
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